Abstract
BACKGROUND: Penile inversion vulvo-vaginoplasty is the most commonly performed genital gender-affirming surgery for transfeminine individuals. Sexual function following vulvo-vaginoplasty has been primarily assessed using instruments developed and validated for cis women. This study aimed to evaluate postoperative sexual function outcomes using the only validated tool specifically designed for trans women. Additionally, potential associations with psychosocial factors were explored. METHODS: Data from trans women who underwent penile inversion vulvo-vaginoplasty without scrotal skin grafts at Klinik Landstraße Vienna were retrospectively analyzed. Sexual function was assessed using the Operated Male-to-Female Sexual Function Index (oMtFSFI), while psychosocial factors were explored through selected items from the Essener Transgender Lebensqualitäts-Inventar (ETLI). Peri- and postoperative complications were extracted from digital medical records and classified according to the Clavien-Dindo classification. Spearman’s r was used to analyze correlations between sexual function and both clinical and psychosocial outcomes. RESULTS: The study included 42 participants (M(age) = 41 years). While general satisfaction was high, sexual function was suboptimal in several domains. Mild to moderate sexual dysfunction (M = 40.6, SD = 8.5) was reported, with the highest scores observed for sexual pain (M = 9.8, SD = 4.0). The observed complications were generally minor and managed conservatively. Significant correlations were found between sexual dysfunction and family acceptance (r = − .48, p ≤ .05), as well as between sexual dysfunction and the ability to openly express one's trans identity (r = − .57, p ≤ .01). CONCLUSION: Penile inversion vulvo-vaginoplasty without scrotal skin grafts is a generally safe procedure, with satisfactory aesthetic outcomes. However, postoperative sexual function remains suboptimal, particularly in terms of sexual pain and genital self-image. These findings suggest that psychosocial factors play a crucial role in postoperative sexual function. Future studies should investigate the impact of surgical techniques, postoperative care, and psychosocial support on sexual health outcomes following gender-affirming vulvo-vaginoplasty. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12894-025-01917-1.